National Hospital Of Sri Lanka Research Articles

Translation, cross-cultural adaptation, and validation of the Duke Activity Status Index (DASI) to Sinhala language

BackgroundDuke Activity Status Index (DASI) is a widely used tool to assess functional capacity among patients, but there is no Sinhala version validated for patients in Sri Lanka. This study aimed to cross-culturally adapt and test the validity and reliability of the Sinhala version of DASI (DASI-S).MethodsThe translation and cross-cultural adaptation of the DASI questionnaire were conducted following the standard guidelines. It was pre-tested on ten pre-operative patients and further modified. The construct validity and reliability of DASI-S were evaluated by administering the modified final DASI-S, which comprised 12 items, along with the physical functioning sub-scale of the 36-item short-form health survey (SF-36), consisting of 10 items to eighty-one patients who were awaiting non-cardiac surgeries at university surgical wards, National Hospital of Sri Lanka (NHSL), and Colombo North Teaching Hospital (CNTH), Sri Lanka. Reliability was assessed through Cronbach alpha, while the validity was evaluated using factor analysis and Spearman’s correlation. The ethical approval was obtained from the Ethics Review Committee, Faculty of Medicine, University of Colombo, Sri Lanka.ResultsThe mean age of the participants was 46.2 (± 16.6) years and the majority were females (54.3%). The mean height, weight, and body mass index of the sample were 160.5 (± 9.6) cm, 60.3 (± 11.9) kg, and 23.4 (± 4.5) kgm−2 respectively. The Cronbach's alpha coefficient for the internal consistency of DASI-S was 0.861. The concurrent validity of DASI-S was substantiated by positively correlating (p < 0.01, rs = 0.466) with the physical sub-scale of SF-36. There was a significant difference (p < 0.01) in the total score of DASI-S between the two age groups.ConclusionsSinhala version of the DASI appears to be a valid, reliable and easy-to-administer tool to assess functional capacity among patients who are awaiting non-cardiac surgeries.

Fasciotomy done for vascular trauma at a tertiary care centre in Sri Lanka

Introduction Compartment syndrome is a major factor contributing to limb loss and poor outcome following lower limb vascular injuries. Method This is a retrospective study done on patients with vascular injuries and undergone fasciotomy at the accident service operation theatre (ASOT) at the national hospital of Sri Lanka (NHSL), during a period of one year. Cases with Incomplete documentation were excluded. Data on patient demographics, time of injury, and time of fasciotomy, associated fractures, muscle viability and outcome were collected. Results A total of 30 cases were included. 26 (86%) were males. Nine (30%) were upper limb and 21(70%) were lower limb fasciotomy. The cause for limb injuries were road traffic accidents (RTA) in 18 (58.1%), trap gun injury in five (16.1%). All the fasciotomy were done prior to revascularization. 19 (63.3%) had fractures (12 (63%) were open and seven (36%) closed). six (20%) fasciotomy were done for compartment syndrome, 24 (80%) were done prophylactically. Three patients with compartment syndrome had open fractures (50%) and three had closed fractures (50%). On fasciotomy, in four cases all four leg compartment muscles were non-viable, two had non-viable three compartments and one patient had non-viable two compartments. The mean delay in patients who had all compartments viable was 3.7 hours (2-6.5) and the mean delay in patients with three or four non-viable compartments was 12.2hours (7-24). This difference was statistically significant (p-0.0001). The fasciotomy delay was also significant (p-0.0001) between the patients who had an amputation and limb salvage. Overall amputation rate was 20% in this series. Mean time of delay from admission to NHSL to the time of fasciotomy was 1.8 hours (1-3.5). Mean time of injury to time of fasciotomy was 5.42 hours (2-24). Discussion Number of non-viable compartments is significantly associated with the duration between time of injury to time of fasciotomy(P-0.0001). Therefore we suggest early fasciotomy before transfer

Clinical characteristics and outcome of cardiac resynchronization therapy for heart failure in National Hospital of Sri Lanka from year 2005 to 2020 – a retrospective observational study

BackgroundCardiac resynchronization therapy (CRT) has been a well-established treatment modality for moderate to severe left ventricular systolic dysfunction with left ventricular desynchrony. This is the pioneering study that analyses the cohort who underwent CRT implantation at the National Hospital of Sri Lanka (NHSL) in Colombo from 2005 to 2020.ObjectivesThis study was carried out to describe socio-demographic factors, improvements in clinical outcome (symptoms, electrocardiographic, and echocardiographic features), and post-CRT complications in the study population, as well as to determine the efficacy of CRT in heart failure.MethodA retrospective observational study was conducted on all the living patients who had undergone CRT implantation from 2005 to 2020. The data was gathered from all the consented patients who visited the device programming clinic using a physician-administered questionnaire and clinical records. Data was analyzed using SPSS 25, and significant statistics were assessed with the McNemer test, the Student T test, and the Chi-Squared test.ResultsThe study included 50 patients with a mean age of 52.82+/− 11.66 years and female predominance (56%, n = 28). Idiopathic dilated cardiomyopathy (50%, n = 25) was the leading etiological factor, followed by ischemic cardiomyopathy (28%, n = 14). Clinical symptoms have improved significantly with CRT implantation (p < 0.001). A significant improvement was found in NYHA functional class (p < 0.001, 95% CI = 0.072 to 0.284), QRS width (p < 0.001, 95% CI = 0.229 to 0.534), ejection fraction (p < 0.001, 95% CI = − 16.437 to − 8.504), and LV EDD (p < 0.001, 95% CI = 2.89 to 9.24). Post-CRT complications included lead malfunction (6%, n = 3) and chronic (14%, n = 7), bleeding or hematoma (2%, n = 1), pocket erosion or infection (6%, n = 3), and infective endocarditis (2%, n = 1).ConclusionAccording to the study, CRT significantly improves both clinical and functional outcomes in patients with moderate to severe heart failure.

Delay in diagnosis to treatment and impact on survival of gastric adenocarcinoma in a low income setting without screening facility

The treatment modality of gastric adenocarcinoma (GCA) depends on the stage of the disease at the clinical presentation. Long delays are probably an unfavorable factor for the patient's prognosis. A prospective longitudinal, study involving 145 consecutive GCA was conducted at the National Hospital of Sri Lanka (NHSL). The overall delay (in weeks) was recorded for each patient and divided into four periods-patient, endoscopy, pathology and treatment. The median and Interquartile Range (IQR) duration of delays were calculated and differences were explored with chi square test and Mann Whitney U test Survival analysis was done with Kaplan Meier technique and Cox regression. The median duration of delays for patient, endoscopy, histology reporting delay, other histology delay (specimen transfer delay and report receipt delay) and treatment were 18 (IQR 14–27), 2 (IQR 2–3), 3 (IQR 2–3), 2 (IQR 1–2) and 6 (IQR 4–8) weeks respectively. Delayed patient presentation to hospital was associated with significant adverse median survival 16 (IQR 11.5–22.5) weeks versus 20 (IQR 16–27.5) weeks, p = 0.004. Delay in initiating treatment was associated with significantly lower median survival 04 (IQR 4–6) weeks versus 06 (IQR 4–8) weeks, p = 0.003. Over 60% of both proximal and distal GCA presented at an advanced radiological stage (stage III/IV). The Kaplan Meier analysis showed that the higher hazard function was associated with a higher tumour stage and undergoing chemotherapy. Age of the patient and the treatment modality were significant predictors of the survival. Patient delay and delay in initiation of definitive treatment are the most important factors that adversely affect the outcomes of GCA. Public health interventions aiming to shorten the patient delay time with proper referral for specialist care would play an important role. Also, it is important to minimize these preventable delays and there should be time limits in producing the histopathology report and to establish online portals of hospital and laboratory information systems for easy access of histology reports in future.

User Experience on a New Medical Supplies Management Information System at The National Hospital of Sri Lanka

Introduction: The new Medical Supplies Management Information System (MSMIS), an e-based logistics management system was implemented in 2023 by the Medical Supplies Division of the Ministry of Health, Sri Lanka to effectively manage medical supplies among state healthcare institutions across the island. The new system replaced the previous MSMIS to incorporate wider aspects of supply chain management on par with the changing environment. Methods: It was a mixed-method descriptive study conducted at the National Hospital of Sri Lanka (NHSL) in 2023. A survey was done with the help of a tailor-made tool (5-point Likert scale) among all the users of MSMIS at NHSL. Key information interviews and observational visits were done to complement the quantitative findings. Objective: The study aimed to evaluate the experiences of users in the new MSMIS by comparing it with the previous one at the NHSL. Results: More than 60% of respondents (n=21) were found to have negative or highly negative experiences with all ten components of the system evaluated. The composite mean score of overall experience was 2.17(SD=0.56). The qualitative data fortified the findings of the quantitative data. Conclusion: The majority of MSMIS users at the NHSL had a negative experience with the new MSMIS in comparison with the previous system. Recommendation: It is recommended for similar studies on a larger scale (regional/national) to produce findings with fewer concerns for validity and reliability.

Study on Ward-Based Practice of Vasopressor Administration for Patients with Sepsis, in National Hospital of Sri Lanka (NHSL)

Background: Vasopressors are administrated peripherally in hemodynamically unstable patients with sepsis in the initial period. International guidelines are available for peripheral administration of vasopressors, including Surviving Sepsis guidelines 2021.Objective: Assess the ward-based practice regarding peripheral administration of vasopressors in patients with sepsis, in NHSL.Methods: A prospective cross-sectional study, during a period of six weeks in 2022, setting of Medical and surgical wards in NHSL, in a group of 52 patients.Results: Noradrenaline was the vasopressor used for all patients with septic shock. 93% of patients had peripheral noradrenaline infusions for a medium duration of 77.7 hours. Peripheral cannula for noradrenaline was sited in the forearm at 46% and in the dorsum of the hand at 34%. Only 7% had a central line for vasopressors. Other infusions along with noradrenaline in the same cannula were given in 75%. Approximately 90% were monitored hourly during the infusion of vasopressors. ICU referral was done only in 5.7% of patients. Adverse reactions were noted in 38% of patients, all minor complications.Conclusion: Peripheral administration of vasopressors was prolonged compared to standard. Adverse reactions were identified, but all were minor complications.

Cost of a routine (planned) cardiac by-pass surgery at the National Hospital of Sri Lanka

Background: Non-communicable disease (NCD) has become a major challenge in Sri Lanka. Over the last 40 years, ischemic heart disease (IHD) has been identified as one of the leading causes of NCD deaths in Sri Lanka. Coronary artery bypass graft (CABG) is a revascularization procedure that has been identified as an effective method for managing a patient with IHD. Therefore, estimating the approximate cost of CABG surgery in a public hospital would help in economic evaluations and managerial decision-making in public sector investments.Objective: To estimate the approximate cost of an uncomplicated routine (planned) cardiac bypass surgery at the National Hospital of Sri Lanka (NHSL), Colombo.Methods: This study was primarily based on secondary data. The data required for costing the procedure was extracted from 52 BHTs of patients who underwent CABG surgery at the NHSL during the last three months of the year 2019. Extracted data was used to determine the costing elements of each cost center. Direct and indirect cost centers were identified, and the cost of each center was determined by apportioning the available cost data by the step-down method using a weighted factor where applicable.Results: The approximate cost of an uncomplicated CABG was Rs. 1.3 million per patient. Out of the total cost, 89% (Rs. 1.16 million) was expended on direct labor as salaries of different categories of staff. A major portion of it (56%) was spent on ICU care (Rs. 0.654 million) followed by post-surgical care at the ward settings (33.9%, Rs. 0.393 million). The highest cost of the material was recorded at the theatre which was 6% of the total cost (Rs. 78,960.00). The cost of total overheads was Rs. 29,517.00 which was about 2.2% of the total. Conclusion: Although the approximate cost of a routine uncomplicated CABG surgery was Rs.1.3 million ($ 7,027) as of December 2019 at the National Hospital of Sri Lanka, compared to more developed countries this is a fairly low cost. However, when the differences between health system organization and per capita health expenditure are concerned, this is quite evident to claim that the Sri Lankan health system has low-cost but effective models of delivering its care to people.

The clinical profile of amyotrophic lateral sclerosis patients presenting to the National Hospital of Sri Lanka

OBJECTIVES Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disease. Published data on ALS in Sri Lanka is scarce. The aim of this study was to describe the clinical profile of ALS patients presenting to the National Hospital of Sri Lanka(NHSL). METHODS A descriptive cross-sectional study was carried out in 33 consecutive patients with “clinically definite ALS” according to revised El-Escorial and Awaji criteria, who presented from May 2018-May 2020 to two neurology units at NHSL. RESULTS The mean age was 59.7 (±12.3) years while 57.6%(n=19) were males. The average duration for diagnosis was 15.48 (±12.4) months. The commonest first symptom was upper limb weakness 39.4%(n=13) followed by lower limb weakness 33.3%(n=11) and bulbar symptoms 27.3%(n=9). According to King’s Staging System, 18.2%(n=6) were in stage 1, 39.4%(n=13) were in stage 2, 36.4%(n=12) were in stage 3 and 3%(n=1) each were in stage 4A and 4B at the time of diagnosis. None had a family history of ALS. Four were treated with Riluzole. Out of all, 45%(n=15), 24.2%(n=8) and 6.1%(n=2) were referred for physiotherapy, occupational therapy and psychiatry assessment respectively. Seventy five percent (18/24) patients with bulbar symptoms, were referred to speech therapists and one had gastrostomy. Advance directives were not discussed with any of the patients. CONCLUSION The ALS patients presenting to the NHSL had a mean age of 59.7yrs with a slight male preponderance. The average duration taken for diagnosis was 15.5months while the commonest first presentation was upper limb weakness. Most present in King’s stage 2 or 3 and only a few were treated with disease modifying agents. Multidisciplinary care provided and management of disease related complications were suboptimal. Discussing about advance directives with ALS patients, is yet not part of Sri Lankan practice. This emphasizes the need to enhance standards of care for ALS patients to improve their quality of life.

Dermatological manifestations among patients with COVID-19: The Sri Lankan experience

Background: Patients diagnosed with COVID-19 demonstrate a wide spectrum of cutaneous manifestations, some of which are at a high prevalence. These manifestations, of which some are unique, have been considered to occur due to COVID-19 infection and the associated inflammatory response. Furthermore, there are reports on exacerbation of previously diagnosed dermatoses and cutaneous side effects of medications and vaccines administered.Methodology: The first phase of the study included a descriptive cross-sectional study conducted at the National Hospital of Sri Lanka (NHSL) among PCR-positive COVID patients to identify their skin conditions. Secondly, to ascertain an overall understanding of the country’s situation, a comprehensive questionnaire was circulated among the members of the Sri Lanka College of Dermatologists, to obtain information on the patients they have encountered.Results: Out of the patients at NHSL only 1.7% (n=8) had developed associated skin manifestations. Two (0.4%) developed novel conditions: thrombophlebitis and a maculopapular exanthem. Six (1.3%) patients had exacerbation of pre-existing conditions including eczema, psoriasis and discoid lupus erythematosus. The dermatologists revealed a wide variety of manifestations with the majority experiencing an exacerbation of pre-existing conditions and a few developing novel lesions including COVID-toes and Kawasaki-like diseases in children which are considered specific for COVID-19.Conclusions: The study demonstrates a range of COVID-19-associated dermatoses. These can present before or with other COVID-19 symptoms. Further, studies are necessary to precisely determine the timing and pathophysiology of different manifestations. Dermatological findings are important and should prompt the early involvement of dermatologists as appropriate.

Prevalence and associated factors of psychological distress of patients with stroke attending the clinics of the National Institute of Neurology of the National Hospital of Sri Lanka, Colombo

INTRODUCTION: Stroke is the fifth leading cause of disability adjusted life years lost in Sri Lanka. A vast range of factors lead to psychological distress among stroke patients causing poor outcomes such as limitations of daily activities, poor rehabilitation outcomes, social isolation, and poor financial recovery. Nevertheless, there is a scarcity of data on this topic, in both foreign and local literature. OBJECTIVES: To assess the prevalence of psychological distress and identify the factors associated with it among the patients with stroke attending the clinics of National Institute of Neurology (NIN), National Hospital of Sri Lanka (NHSL), Colombo. METHODS: A descriptive cross-sectional study with an analytical component was conducted among 177 patients with stroke attending the clinics of National Institute of Neurology, National Hospital of Sri Lanka, Colombo who were sampled by multistage random sampling. The 10-item Kessler psychological distress scale was used to assess the psychological distress while the Barthel Index and the modified Rankin Scale were used to assess the dependence on the Activities of Daily Living (ADL) and disability status respectively. Data was collected regarding socio-demographic, behavioral, family and caregiver, stressful life events, stroke and other health related factors using a pretested interviewer administered questionnaire. Chi-square tests, simple logistic regression was used for bivariate analysis followed by multivariate analysis via binary logistic regression. Results obtained from the final regression model were expressed using odds ratios with 95% confidence intervals whilst associations with p-value &lt; 0.05 were significant in all types of analyses. RESULTS: The mean age of the participants with stroke was 59.6 (SD 12.285) years. The prevalence of psychological distress among stroke patients was found to be 23.3% (95% CI: 16.1 - 31.9) using the validated K10 score of ≥22. During bivariate analysis, none of the sociodemographic, family and caregiver related, and stressful life event related factors were significantly associated while past personal history and family history of psychiatric disorders, frequency of engagement in physical and leisure time activities prior to the stroke event, time since the last stroke event, level of disability and dependence on ADL (p &lt; 0.05) were found to be significant predictors of psychological distress. The results of regression identified five independent predictors with a R2 of 0.772. There, the presence of psychological distress was significantly predicted by age (b = -.134, p &lt; 0.05), gender (b = 4.262, p = 0.05), patient being the sole source of income (b = 3.207, p &lt; 0.05), ii level of disability (b = 2.568, p &lt; 0.001) and past personal history of psychiatric disorders (b = 5.151, p &lt; 0.05). CONCLUSION: The prevalence of psychological distress among patients with stroke attending the clinics of the NIN, NHSL, Colombo is high and is associated with several health and non-health related factors. A standard routine screening method should be formulated for early diagnosis of patients at risk of psychological distress supplemented by a multidisciplinary approach including psychosocial support starting from the initial out-patient management of stroke patients.

Factors associated with time to presentation of patients to rheumatology clinics at the National Hospital of Sri Lanka

Background: Delay in diagnosis of rheumatic diseases is associated with less favorable outcomes. However, there is paucity of local data on diagnostic delay. Therefore, the aim of this study was to describe factors associated with time to presentation of patients to rheumatology clinics at the National Hospital of Sri Lanka (NHSL).Methods: A descriptive cross-sectional study was conducted at the three rheumatology clinics of NHSL. A total of 120 patients whose first presen- tation to the clinics had been within 6 weeks period to the date of data collection were recruited using systematic sampling. An interviewer administered questionnaire was used. Patient delay, healthcare delay and total delay were the three main aspects of delays considered.Results: The median total delay in presentation was 12 months, patient delay was 6 months and healthcare delay was 6 months. Increasing age (p=0.013), high monthly income (p=0.007) and patients diagnosed with rheumatoid arthritis (p=0.018) showed a significant positive association with delay in presentation while mechanical backache (p=0.022), neck pain (p=0.044) and systemic lupus erythematosus (p=0.044) showed negative association with delay in presentation. Gender, education level, pattern of joint involvement and health seeking behaviors were not associated with delay.Conclusion: There was a significant delay in presentation of the overall study population to the rheumatology clinics. Increasing age, high monthly income and patients diagnosed with rheumatoid arthritis was associated with delayed presentation.

Decompressive craniectomy for traumatic brain injury: outcomes and their determinants

Decompressive craniectomy (DC) is a management option to control raised Intracranial pressure (ICP) in Traumatic Brain Injury (TBI) with inconsistent evidence for its outcomes and their determinants. The aim of this study was to assess the outcomes and determinants of outcomes of DC done in National Hospital of Sri Lanka (NHSL) at one year and three years of follow-up. Patients who underwent DC for TBI within 6 months period from 01/02/2016 to 31/07/2016 at Neurotrauma Centre, NHSL were included in the study. Data were retrieved from medical records. Outcomes were evaluated by interviewing patients/relatives over the telephone using standard questionnaire for extended Glasgow Outcome scale (GOS-E). Inclusion and exclusion criteria matched 118 patients were selected and 89 (75.42%) contactable patients were included in the analysis. Majority (86.4%) were males and median age was 45 years. There were 56 primary DCs and 33 secondary DCs. Favorable outcomes (GOS-E 5-8) were seen in 20.2% and in 24.7% at the end of one year and three years respectively. Younger age, good pupillary reaction and higher GCS on admission were associated with statistically significant favorable outcomes (P<0.05). Pupillary symmetry, timing of DC (primary or secondary), time elapsed from time of injury to performing primary DC, type of DC, whether CT shows an isolated lesion or multiple lesions, submission to tracheostomy, having medical comorbidities and post-operative infections were not predictive of the outcome. Favorable functional outcomes following DC for TBI is limited to 20-25%. Younger age, good pupillary reaction and higher GCS are predictors of favorable functional outcomes.

HIV Prevalence among Meical Inward Patients in the National Hospital of Sri Lanka (NHSL) with the Assessment of Patient Acceptance, the Feasibility and Challenges of the Hospital Based Rapid HIV Diagnostic Test

<strong>Introduction: </strong>Hospital based HIV Rapid Diagnostic Testing (RDT) was introduced in 2018, following programmatic decision. However, being the province with the highest HIV prevalence in the country, the number of hospital based rapid testing carried out in Western province was not impressive, leading to missed opportunities and late diagnosis. Therefore, RDT was re-implemented in selected medical wards of NHSL. <strong> </strong> <strong>Objective: </strong>To assess the case detection rate, the feasibility and challenges of the rapid HIV testing services among inpatients of medical wards of NHSL. <strong> </strong> <strong>Method: </strong>A descriptive demonstration study, carried out among consecutive 3,395 new admissions to selected medical wards of the NHSL within three months period. HIV status was tested on finger prick blood, using FDA and WHO approved 4th generation HIV RDT (with 100% sensitivity, 99.7% specificity) following informed consent. Patient information were extracted from bed head tickets. Focus Group Discussions (FGD) were carried out with the relevant hospital staff to assess the challenges. Confidentiality of patients ensured by training all the health care workers involved in RDT and followed up of the positive test results, according to the national guidelines <strong> </strong> <strong>Results: </strong>Among the 3395 participants, eight (8) were found to be positive, with the HIV prevalence of 0.23 %. The patient acceptance rate was 96%. Out of the positives, majority were males (n=6) and married (n=5) and half of them were from the Colombo district. Only two (25 %) had AIDS defining symptoms while the majority (n=5) had baseline CD4 count less than 200 cells/μl . Work overload, consent taking, lack of confidence in post-test HIV counselling were identified as major areas of concern. <strong> </strong> <strong>Conclusions: </strong>Hospital-based HIV rapid testing is one of the high yielding programmatic strategies implemented in the country so far. The positivity rate of the study sample was 0.23% which is higher than the HIV positivity rate reported through different testing strategies including the general public (0.03%), and STD samples (0.1%). Further, beating up the challenge of missed opportunities and late diagnosis was highlighted. Therefore, addressing the identified barriers through policy and administrative support and further scaling up of hospital-based HIV testing is highly recommended.

Maxillary swing approach - Sri Lankan experience

Introduction:The maxillary swing approach is one of the trans maxillary surgical approach techniques used in otorhinolaryngology. It gives wide exposure to the nasopharynx, orbital apex, sphenoid sinus pterygopalatine fossa, infra temporal fossa and middle cranial base. This enables en bloc resections of tumour and proper visualization. Objectives:To study patients who underwent this procedure during the last five years with regard to indication, technique, and complications.To compare our patient outcomes with the published literature.To identify the factors leading to complications with recommendations to reduce them in the future.Methods:Retrospective analytical study was done on patients operated from 2015 to 2020 at the ENT Unit C of the National Hospital of Sri Lanka (NHSL).Results:A total of 14 patients underwent maxillary swing approach during the study period. The most common indication was angiofibroma. About 28% had an unacceptable scar following the surgery, which was the most occurring complication while 2 patients had recurrences during this period.Conclusion:Maxillary swing is a useful surgical approach with no major complications in our series. Commonest complication was an unacceptable scar (28%). Other complications were palatal fistula and nasal speech. It is postulated that further refinement of the technique will reduce these complications.

Attitudes Toward Information Technology Among Operating Theatre Nurses in Sri Lanka

Incorporating the use of information and communication technologies (ICT) into everyday professional practice requires nurses to overcome resistance to change and to become willing users and creative operators of IT. Managing the change process effectively while implementing eHealth (e.g., Hospital Information Systems) within the operating theatre environment can facilitate the efficient delivery of quality patient care. Aim: To describe the uses of and attitudes toward current IT by operating theatre nurses at The National Hospital of Sri Lanka (NHSL). Methods: The research used a descriptive design and survey method. The study population was theatre nurses working in 16 theatres. A convenience sample of 112 nurses selected from the 16 theatres was used. Nurses with a service period over 20 years were excluded. Data were gathered with a self-administered questionnaire. Results: The response rate was 97 of 112 (87%). The study found that nurses were highly confident in using computers, touch screens, the Internet and email. Almost 80% of theatre nurses used computer technology for their work and personal matters. However only 60% of the nurses had personal email addresses. Furthermore, 79% of nurses believed that computers would reduce paper work. Conclusion: Most operating theatre nurses possess a positive attitude toward advances that use IT applications. This may be due to the growing presence and accessibility of IT in their work environment, which has added value in their day to day practice in the hospital. To facilitate ongoing growth in use of IT in Sri Lanka, continuing education opportunities for operating theatre and other nurses should be pursued.

Factors associated with hospital-acquired infections among the intensive-care patients in a tertiary-care hospital in Sri Lanka and the nurses’ knowledge on precautionary measures

Background: Patients in Intensive Care Units (ICUs) are at a higher risk of developing Hospital Acquired Infections (HAIs). Therefore, the health staff in ICUs should have an adequate knowledge about the precautions to be taken to minimize HAIs in ICUs. Objectives: The aim of this research was to assess the prevalence of HAIs and their associated factors among the patients treated in ICUs at the National Hospital of Sri Lanka (NHSL) and to access the knowledge among nursing officers on precautions taken to minimize HAIs. Methods: This descriptive cross-sectional study had two components. For the first component, 110 patients being treated for more than 48 hours at ICUs at NHSL were recruited by consecutive sampling. A data was extracted from hospital records. Descriptive statistics and chi square test were used to analyze the data. The second component was conducted among 125 nursing officers working at ICUs at NHSL who were selected by convenience sampling. A self-administered questionnaire was used to assess their knowledge regarding precautions taken to minimize HAIs. Descriptive statistics were used to describe the knowledge. Results: The prevalence of Ventilator Associated Pneumonia (VAP), hospital acquired Urinary Tract Infections (UTIs) and cannula associated Blood Stream Infections (BSIs) were 29.3%, 10% and 5.5% respectively. The duration of stay (p=0.001), diabetes mellitus (p=0.008) and long-term use of antibiotics (p=0.001) were significantly associated with VAP while only long-term use of antibiotics was significantly associated with hospital acquired UTIs. Among the nursing officers 46.4% had scored above 75% for the knowledge questionnaire. Conclusions and recommendations: Our studies showed that HAIs are prevalent in the ICUs in NHSL and the health care staffs need to improve their knowledge and take interventions to minimize these infections.

MON-PO625: Clinical Audit on Tube Feeding Practices of Intensive Care Units (ICU) in National Hospital of Sri Lanka (NHSL)

MON-PO625: Clinical Audit on Tube Feeding Practices of Intensive Care Units (ICU) in National Hospital of Sri Lanka (NHSL)

Vancomycin resistant enterococcal (VRE) colonization among patients treated in intensive care units at the National Hospital of Sri Lanka, and determination of genotype/s responsible for resistance

The aim of this study was to assess the epidemiology of VRE colonization among patients in the intensive care units (ICU) of the National Hospital of Sri Lanka (NHSL). A cross sectional study was carried out on 218 patients admitted to 12 ICUs of the NHSL from January to March 2012. Rectal swabs were collected on day 0, 4, 8 and every 4th day thereafter till discharge. Enterococci were isolated on selective media and identified up to species level using standard bacteriological procedures. Standardized disc diffusion antibiotic susceptibility testing to ampicillin, teicoplanin and vancomycin was performed using the Clinical and Laboratory Standards Institute (CLSI) method. Minimum inhibitory concentrations to vancomycin were determined, using the E-test in strains showing intermediate or frank resistance to vancomycin by disc diffusion. Genotype determination (van A / van B) was carried out on isolates identified as VRE using the polymerase chain reaction. Patients positive for VRE colonization were followed up to discharge or death. VRE prevalence in the study sample was 5%. Univariate analysis showed that the use of metronidazole (odds ratio [OR] :15.73;95% 95% confidence interval [CI] : 3.94-62.67,P<0.05) or teicoplanin (OR: 12.56; 95% CI:2.65 – 59.52, p< 0.05) and diabetes (OR: 05.13; 95% CI: 1.36 – 18.7, p< 0.05) or hemodialysis during ICU stay (OR: 7.38 ;95% CI : 1.69-32.16, P<0.05) were associated with an increased risk of VRE colonization. The 5% prevalence of VRE colonization detected signals the emergence of VRE in the intensive care setting in Sri Lanka.

Knowledge on HIV transmission and attitude towards providing care for people living with HIV (PLWHA) and adherence to univer sal precautions (UP) among attendants in the National Hospital of Sri Lanka (NHSL)

Knowledge on HIV Transmission and attitude towards providing care for people living with HIV (PLWHA) and adherence to universal precautions (UP) among attendants in the National Hospital of Sri Lanka (NHSL) Nanayakkara G A G 1, Karawita D A2 Abstract Introduction: HIV transmission knowledge, misconceptions in the society and adherence to universal precautions directly attribute to handling of PLWHIV by healthcare workers. This study was done to assess the knowledge on HIV transmission and attitudes towards PLWHIV ,Knowledge on Universal Precautions and the adherence in work place among attendants working in the NHSL. Objectives: Methods: Descriptive cross sectional study was conducted among 224 randomly selected sample of health attendants. Interviewer administered questionnaire was used for data collection which included assessments for HIV transmission knowledge (score 0-10), knowledge on universal precautions (score 0-9) and attitudes towards PLWHIV (score 0-8), final scores were computed to percentage values. Data were analysed using SPSS v23. Results: Mean age of the participants was 42 years (SD=10.41)and majority (66%) were married males. Most of them (60.3 %) had less than 10 years of working experience. A significant number had already given care to an HIV infected (65.2%). Mean values for “HIV transmission knowledge”, “adherence to Universal precautions”, and “positive attitudes for HIV care” were 84%, 40% and 70% respectively. Increased service duration significantly reduced both HIV transmission knowledge (r=-0.142: p&lt;0.001) and knowledge on universal precautions(r=-0.299: p&lt;0.001). Furthermore, increasing age also, was negatively associated with knowledge on UP (r=-0.393: p&lt;0.001). Conclusions: Knowledge on HIV transmission, and positive attitude for HIV care was over 70% but adherence to universal precautions was only 40%. Increasing service duration reduce the HIV transmission knowledge and Knowledge on UP. Regular updating of knowledge regarding HIV transmission ,and on UP by in-service programme should be done and special attention should be paid on the attendants in the elderly age group who have longer service duration. Key Words: Knowledge, HIV, Attendants, attitudes

Critical Analysis of Clinical Waste Management System in National Hospital of Sri Lanka

Health care waste at the National Hospital of Sri Lanka (NHSL) consists of infectious, hazardous as well as nonhazardous waste generated at various places within the institution. Health care waste management function in the NHSL is outsourced to a private company. Waste Management needs due attention and if the procedure did not follow the safe methods definitely create a great problem to the patients, staff as well as the public and the environment. The segregation of waste at the selected units was satisfactory. All (100%) units had a sharp bin to separately collect needles and other sharp materials. They used color code in waste bins. Occupational safety measures take during handling waste were not satisfactory. None of them were found wearing protective gloves, masks or boots. Even though the wards practice segregation of waste according to the color code, the transportation of waste from wards to the disposal area was unhealthy and not up to the standards. This was mainly due to the carelessness of the staff, supervisors and the cleaning service workers. The knowledge on safe handling and transporting waste among waste handlers were not adequate thus they deserves for training on healthcare waste management.